Methods, systems, and devices for surgical suturing

ABSTRACT

Various exemplary methods, systems, and devices for surgical suturing are provided. In general, a loading element can be configured to facilitate loading of a plate into a surgical instrument configured to facilitate passage of a suture through tissue. The surgical instrument can be configured to advance the suture through a tissue of a patient, to capture a free end or looped end of the suture after the suture&#39;s advancement through the tissue, and to pull the captured suture out of the patient&#39;s body with a portion of the suture remaining passed through the tissue within the patient&#39;s body.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.16/106,719, filed on Aug. 21, 2018, and entitled “Methods, Systems, AndDevices for Surgical Suturing,” which is a divisional of U.S. patentapplication Ser. No. 14/820,067 (now U.S. Pat. No. 10,080,562), filedAug. 6, 2015, and entitled “Methods, Systems, and Devices for SurgicalSuturing,” which are hereby incorporated by reference in theirentireties.

FIELD

The present disclosure relates generally to methods, systems, anddevices for surgical suturing.

BACKGROUND

Suturing apparatus in the past have been required to have an elongateconfiguration and a low profile facilitating their use through cannulasin less invasive surgery. These devices have typically included opposingjaws which clamp on to the tissue to be sutured. Beyond this simpleclamping motion, typically facilitated by scissor handles, the mechanismfor threading a suture between the jaws and through the tissues havebeen exceedingly complex.

This complexity has derived primarily from the fact that the elongated,low profile configuration calls for an operating force that can betransmitted through an elongate tube. This force along the axis of theinstrument must then be converted into a force extending generallyperpendicular to the axis between the jaws. No simple structure has beendevised to accommodate this transition. Furthermore, loading a sutureonto a mechanism has also been complicated due to the complexity of thesuturing mechanisms.

Accordingly, there remains a need for improved methods, systems, anddevices for surgical suturing.

SUMMARY

In general, methods, systems, and devices for surgical suturing areprovided.

In one aspect, a surgical system is provided that in one embodimentincludes an outer member and an inner member. The outer member has aninternal cavity therein and has proximal and distal ends. The proximalend of the outer member has an opening therein that is in communicationwith the internal cavity. The inner member has proximal and distal endsand is an independent element from the outer member. The distal end ofthe inner member is configured to be inserted through the opening of theouter member and into the internal cavity of the outer member. The innermember includes a seat configured to removably and replaceably receive aplate therein. The proximal end of the inner member has a bore formedtherein. The bore is configured to receive therein a distal end of asurgical instrument. The inner and outer members are configured to causethe plate to advance into the bore from the seat in response to theinner member being inserted into the internal cavity.

The surgical system can have any number of variations. For example, thesystem can include a plate configured to removably and replaceably bereceived in the seat. The plate can be configured to facilitate passageof a suture through tissue. For another example, the outer member canhave an internal protrusion that extends into the internal cavity. Theinternal protrusion can be configured to push the plate into the borefrom the seat. For yet another example, the inner member can have asingle position relative to the outer member in which the inner memberis configured to be inserted through the opening of the outer member andinto the internal cavity of the outer member. For still another example,the inner member can have a slot formed in an external surface thereof.The slot can have an open proximal end and a closed distal end. Foranother example, the inner member can include a stop element configuredto stop movement of the inner member in the distal direction within theinternal cavity once the inner member has advanced a predeterminedamount into the internal cavity. For yet another example, in response tothe plate being fully advanced into the bore from the seat, at least oneof the inner and outer members can be configured to generate at leastone of an audible confirmation and a tactile confirmation of the fulladvancement.

For another example, the inner and outer members can have correspondingengagement members configured to orient the inner and outer membersrelative to one another in a predetermined orientation. The engagementmember of one of the inner and outer members can include a slot, and theengagement member of the other of the inner and outer members caninclude a protrusion configured to slide within the slot during theadvancement of the inner member in the distal direction into theinternal cavity.

For yet another example, the inner member can have one or more ribsformed on a top surface thereof. The one or more ribs can be configuredto at least one of prevent the inner member from backing out of theouter member in a proximal direction until a predetermined amount offorce is applied to at least one of the inner and outer members, andlimit movement of the inner member in the distal and proximal directionsrelative to the outer member until a predetermined amount of force isapplied to at least one of the inner and outer members.

For still another example, the surgical system can include a surgicalinstrument having a distal end configured to be received within the boreof the inner member. The inner and outer members can be configured tocause the plate to advance from the seat into the distal end of thesurgical instrument within the bore of the inner member. The distal endof the surgical instrument can include a pair of jaws configured to movebetween open and closed positions. The bore can be configured to receivethe pair of jaws therein with the pair of jaws in the closed position.The distal end of the surgical instrument can be configured to beinserted into the bore of the inner member in a single predeterminedorientation relative to the inner member.

In another aspect, a surgical method is provided that in one embodimentincludes inserting the distal end of the surgical instrument into thebore of the inner member of the surgical system. The inserting isperformed by a user, and the inserting causes the plate to advance intothe bore from the seat such that the plate advances into the distal endof the surgical instrument. The method also includes removing from thebore the distal end of the surgical instrument having the plate advancedtherein. The method can have any number of variations.

In another embodiment, a surgical system is provided that includes asurgical instrument, a plate, and a loading element. The surgicalinstrument includes at a distal end thereof first and second jawsconfigured to grasp tissue therebetween. The surgical instrument isconfigured to pass a suture through tissue. The plate is configured tofacilitate the passage of the suture through the tissue. The loadingelement includes an outer housing and an inner housing that isconfigured to be seated at least partially within the outer housing. Atleast one of the inner and outer housings can be movable relative to theother. The inner housing can be configured to removably and replaceablyseat the plate in a loading configuration. The inner housing can beconfigured to receive at least a portion of the first jaw therein. Whenthe inner housing is seated at least partially within the outer housing,the plate is seated in the inner housing, and at least the portion ofthe first jaw is received in the inner housing, movement of the outerhousing relative to the inner housing is configured to cause the plateto move into the first jaw in a loaded configuration.

The surgical system can vary in any number of ways. For example, thefirst and second jaws can be configured to move between open and closedpositions. At least the portion of the first jaw can be configured to bereceived in the inner housing when the first and second jaws are in theclosed position. For another example, the surgical instrument caninclude an elongate shaft having the first and second jaws at a distalend thereof. The elongate shaft can define a first longitudinal axis.The inner housing can have a bore formed therein that defines a secondlongitudinal axis. The bore can be configured to receive at least theportion of the first jaw therein with the first and second longitudinalaxes being substantially parallel to one another.

In another aspect, a surgical method is provided that includes insertinga distal end of a surgical instrument into a bore formed in a proximalend of an inner housing of a loading element. The inner housing isremovably and replaceably seating a plate. The surgical instrument isconfigured to pass a suture through tissue. The method also includesmoving at least one of the inner housing and an outer housing of theloading element relative to the other, thereby causing the plate to movefrom being seated in the inner housing to being seated in the distal endof the surgical instrument.

The method can vary in any number of ways. For example, the distal endof the surgical instrument can include a pair of jaws configured to movebetween open and closed positions. The pair of jaws in the closedposition can define a first longitudinal axis, the bore of the innerhousing can define a second longitudinal axis, and the distal end of thesurgical instrument can be inserted into the bore with the first andsecond longitudinal axes being substantially parallel to one another.Inserting the distal end of the surgical instrument into the bore caninclude inserting the pair of jaws in the closed position into the bore.

For another example, the surgical instrument can include an elongateshaft extending distally from a proximal handle of the surgicalinstrument. The elongate shaft can define a first longitudinal axis, thebore of the inner housing can define a second longitudinal axis, and thedistal end of the surgical instrument can be inserted into the bore withthe first and second longitudinal axes being substantially parallel toone another.

For still another example, the method can include engaging the tissuewith the distal end of the surgical instrument, and actuating thesurgical instrument so as to cause the surgical instrument to pass thesuture through the engaged tissue, thereby causing deflection of theplate seated in the distal end of the surgical instrument.

In another embodiment, a surgical method is provided that includesseating a loading element having a plate seated therein onto a distalend of a surgical instrument by advancing the loading element in a firstdirection relative to the distal end of the surgical instrument. Thesurgical instrument is configured to pass a suture through tissue. Themethod also includes advancing in a second direction the loading elementseated on the distal end of the surgical instrument, thereby causing theplate to move from a seated condition in the loading element to a seatedcondition in the distal end of the surgical instrument. The seconddirection is substantially perpendicular to the first direction. Themethod also includes removing the loading element from the surgicalinstrument, the plate remaining seated in the distal end of the surgicalinstrument.

The method can have any number of variations. For example, the seconddirection can be a direction toward a handle at a proximal end of thesurgical instrument. For another example, the distal end of the surgicalinstrument can include a pair of jaws, and the plate being seated in thedistal end of the surgical instrument can include the plate being seatedin one of the jaws. The method can also include grasping tissue with thepair of jaws, and actuating the surgical instrument so as to cause thesurgical instrument to pass the suture through the grasped tissue,thereby causing deflection of the plate seated in the surgicalinstrument.

BRIEF DESCRIPTION OF DRAWINGS

This invention will be more fully understood from the following detaileddescription taken in conjunction with the accompanying drawings, inwhich:

FIG. 1 is a side schematic view of one embodiment of a surgicalinstrument configured to pass a suture through tissue;

FIG. 2 is a perspective view of the surgical instrument of FIG. 1 andone embodiment of a needle loadable therein;

FIG. 3 is a top view of one embodiment of a retainer plate;

FIG. 4 is a perspective view of the plate of FIG. 3;

FIG. 5 is a top view of another embodiment of a retainer plate;

FIG. 6 is a top view of a distal portion of another embodiment of aretainer plate;

FIG. 6A is a top view of the distal portion of the plate of FIG. 6having a suture coupled thereto;

FIG. 7 is a top view of a distal portion of yet another embodiment of aretainer plate;

FIG. 8 is a perspective view of a distal portion of another embodimentof a surgical instrument configured to pass a suture through tissue;

FIG. 9 is a perspective view of part of the distal portion of thesurgical instrument of FIG. 8;

FIG. 10 is a perspective view of an upper jaw of the surgical instrumentof FIG. 8;

FIG. 11 is a perspective view of the surgical instrument of FIG. 8having the plate of FIG. 3 loaded therein, engaging a suture, andengaging a material representative of tissue;

FIG. 12 is a top view of the surgical instrument of FIG. 11 having theplate loaded therein and having the suture being removed from thesurgical instrument;

FIG. 13 is a top view of the surgical instrument of FIG. 12 having theplate loaded therein and having the suture removed from the surgicalinstrument;

FIG. 14 is a perspective view of a distal portion of yet anotherembodiment of a surgical instrument configured to pass a suture throughtissue, the surgical instrument having the plate of FIG. 3 loadedtherein;

FIG. 15 is a perspective view of a distal portion of still anotherembodiment of a surgical instrument configured to pass a suture throughtissue, the surgical instrument having the plate of FIG. 3 loadedtherein;

FIG. 16 is a perspective cross-sectional view of a distal portion of oneembodiment of an end effector of a surgical instrument configured topass a suture through tissue;

FIG. 17 is a another perspective cross-sectional view of the distalportion of the end effector of FIG. 16;

FIG. 18 is a perspective view of a distal portion of a top jaw of theend effector of FIG. 16;

FIG. 19 is an enlarged view of part of the distal portion of the top jawof FIG. 16;

FIG. 20 is a perspective view of one embodiment of a loading element,the loading element having the plate of FIG. 3 seated therein;

FIG. 21 is a bottom view of the loading element of FIG. 20 without theplate seated therein;

FIG. 22 is a side cross-sectional schematic view of the loading elementand the plate of FIG. 20, the loading element having a distal portion ofan upper jaw of an end effector seated therein;

FIG. 23 is a perspective view of another embodiment of a loadingelement, the loading element having the plate of FIG. 3 seated thereinand having a distal portion of the surgical instrument of FIG. 15 seatedtherein;

FIG. 24 is a perspective view of the loading element of FIG. 20 and of adistal portion of another embodiment of a surgical instrument configuredto pass a suture through tissue;

FIG. 25A is a top view of the loading element of FIG. 24 in a loadingposition on the surgical instrument of FIG. 24;

FIG. 25B is an enlarged portion of FIG. 25A;

FIG. 26 is another side view of the loading element of FIG. 24 and ofthe distal portion of the surgical instrument of FIG. 24;

FIG. 27A is a top view of the loading element of FIG. 25A in a loadedposition on the surgical instrument of FIG. 25A;

FIG. 27B is an enlarged portion of FIG. 27A;

FIG. 28 is a top view of the loading element of FIG. 27A being removedfrom the surgical instrument of FIG. 27A;

FIG. 29 is a perspective view of the plate of FIG. 28 being removed fromthe loading element of FIG. 28;

FIG. 30 is a perspective view of yet another embodiment of a loadingelement, the loading element including an inner member and an outermember;

FIG. 31 is a bottom schematic view of the loading element of FIG. 30;

FIG. 32 is a perspective schematic view of the loading element of FIG.30;

FIG. 33 is yet another perspective view of the loading element of FIG.30;

FIG. 34 is a side view of the loading element of FIG. 30;

FIG. 35 is a top view of the loading element of FIG. 30;

FIG. 36 is a perspective schematic view of the outer member of FIG. 30;

FIG. 37 is another perspective schematic view of the outer member ofFIG. 36;

FIG. 38 is a perspective view of the outer member of FIG. 36;

FIG. 39 is a perspective view of the inner member of FIG. 30;

FIG. 40 is a side view of the inner member of FIG. 39;

FIG. 41 is another perspective view of the inner member of FIG. 39;

FIG. 42 is a perspective view of a first lateral half of the innermember of FIG. 39;

FIG. 43 is a perspective view of a second lateral half of the innermember of FIG. 39;

FIG. 44 is a perspective cross-sectional view of the loading element ofFIG. 30 having the plate of FIG. 3 loaded therein and having loadedtherein a distal portion of an end effector of another embodiment of asurgical instrument configured to pass a suture through tissue;

FIG. 45 is a top view of a distal portion of another embodiment of asurgical instrument configured to pass a suture through tissue, theinstrument having the plate of FIG. 3 loaded in an end effector thereof;

FIG. 46 is a perspective view of a suture being loaded by hand into theend effector of FIG. 45;

FIG. 47 is a perspective view of the suture of FIG. 46 continuing to beloaded by hand into the end effector of FIG. 46;

FIG. 48 is a perspective view of the suture of FIG. 47 loaded into theend effector of FIG. 47;

FIG. 49 is a perspective view of a distal portion of the surgicalinstrument of FIG. 48 inserted into a body of a patient with jaws of theend effector open around a rotator cuff tissue, an insert showing aproximal portion of the instrument being held by hand;

FIG. 50 is a perspective view of the jaws of the end effector of FIG. 49clamped on the rotator cuff tissue, an insert showing the proximalportion of the surgical instrument being held by hand;

FIG. 51 is a perspective view of a needle and the suture of FIG. 48advanced through the rotator cuff tissue of FIG. 50 clamped by the jawof the end effector;

FIG. 52 is a perspective view of the suture of FIG. 51 advanced throughthe rotator cuff tissue clamped by the jaw of the end effector, theneedle having been retracted;

FIG. 53 is a perspective view of the jaws of the end effector of FIG. 52opened with the suture passed through the tissue held by the jaws of theend effector;

FIG. 54 is a perspective view of the jaws of the end effector of FIG. 53closed with the suture passed through the tissue held by the jaws of theend effector;

FIG. 55 is a perspective view of the suture of FIG. 54 passed throughthe rotator cuff tissue and a plurality of additional sutures passedthrough the rotator cuff tissue; and

FIG. 56 is a perspective view of a suture anchor anchoring the suturesof FIG. 55.

DETAILED DESCRIPTION

Certain exemplary embodiments will now be described to provide anoverall understanding of the principles of the structure, function,manufacture, and use of the devices and methods disclosed herein. One ormore examples of these embodiments are illustrated in the accompanyingdrawings. Those skilled in the art will understand that the devices andmethods specifically described herein and illustrated in theaccompanying drawings are non-limiting exemplary embodiments and thatthe scope of the present invention is defined solely by the claims. Thefeatures illustrated or described in connection with one exemplaryembodiment may be combined with the features of other embodiments. Suchmodifications and variations are intended to be included within thescope of the present invention.

Further, in the present disclosure, like-named components of theembodiments generally have similar features, and thus within aparticular embodiment each feature of each like-named component is notnecessarily fully elaborated upon. Additionally, to the extent thatlinear or circular dimensions are used in the description of thedisclosed systems, devices, and methods, such dimensions are notintended to limit the types of shapes that can be used in conjunctionwith such systems, devices, and methods. A person skilled in the artwill recognize that an equivalent to such linear and circular dimensionscan easily be determined for any geometric shape. Sizes and shapes ofthe systems and devices, and the components thereof, can depend at leaston the anatomy of the subject in which the systems and devices will beused, the size and shape of components with which the systems anddevices will be used, and the methods and procedures in which thesystems and devices will be used.

Various exemplary methods, systems, and devices for surgical suturingare provided. In general, a loading element (also referred to herein asa “loader”) can be configured to facilitate loading of a plate (alsoreferred to herein as a “retainer plate”) into a surgical instrumentconfigured to pass a suture through tissue. The surgical instrument canbe configured to advance the suture through tissue of a patient, tocapture a free end or looped end of the suture after the suture'sadvancement through the tissue, and to pull the captured suture out ofthe patient's body with a portion of the suture remaining passed throughthe tissue within the patient's body. The suture can be passed through avariety of tissues, and the suture's passage may be useful in a varietyof surgical procedures, as will be appreciated by a person skilled inthe art. For example, the suture can be passed through a rotator cufftissue in a rotator cuff repair procedure.

Although the surgical instrument may securely capture the suture afterthe suture's passage through tissue, in some instances, the surgicalinstrument's grasp of the suture may not be as secure as in otherinstances due to any one or more factors such as size of the suture,material forming the suture, anatomy of the patient, lack of userexperience, and size of the tissue. Pulling the suture out of thepatient's body may thus be difficult since the suture may be slip fullyout of the surgical instrument's grip and/or become less tightly held bythe surgical instrument during the pull-out process. The suture slippingfully out of the surgical instrument's grasp may require re-capturingthe suture within the patient's body, which can be cumbersome and/ortime-consuming. The suture becoming less tightly held by the surgicalinstrument while the captured suture is being pulled out of thepatient's body may require a user manipulating the surgical instrumentto apply an increased force to pull out the suture, which may bedifficult given the user's strength and/or surgical space constraints,and/or may require the suture to be pulled out of the patient's body atan awkward angle. Even when the suture is securely captured by thesurgical instrument after the suture's passage through tissue, thesuture may slip fully out of the surgical instrument's grip (e.g., dueto the pulling force) while the captured suture is being pulled out ofthe patient's body such that the suture must be re-captured within thepatient's body, and/or the suture may become less tightly held by thesurgical instrument while the captured suture is being pulled out of thepatient's body such that a user manipulating the surgical instrumentmust apply an increased force to pull out the suture.

The plate loaded into the surgical instrument can be configured tofacilitate manipulation of the suture. In particular, the plate can beconfigured to facilitate the instrument's capture of a suture after thesuture has been passed through the tissue, which may facilitate securepulling of the suture out of the patient's body. The plate can beconfigured to be loaded into an end effector at a distal end of thesurgical instrument. The end effector can be configured to capture thesuture after the suture has been passed through the tissue. The platecan be configured to facilitate the end effector's grasp of the capturedsuture, e.g., strengthen the instrument's grasp of the suture, andthereby help prevent the suture from fully slipping out of the endeffector and help prevent the suture from becoming less securely held bythe end effector after the suture's capture by the end effector.

It may be difficult to load the plate into the surgical instrument,e.g., into the instrument's end effector, for one or more reasons. Forexample, the plate can be a relatively small element that may bedifficult for a user to manipulate by hand and load into the instrument.For another example, the plate can be configured to deform in shape inresponse to the instrument's capturing of the suture, but thisdeformability may allow the plate to deform during its loading into theinstrument. The plate being loaded into the instrument in a deformedstate may reduce the plate's effectiveness in helping the instrument tohold onto the captured suture. For yet another example, it may bedifficult for a user to recognize whether or not the plate is properlyloaded into the instrument, e.g., because it may be difficult tovisually observe the plate within the end effector, because the user isinexperienced, etc. Improper loading of the plate into the instrumentmay reduce, if not entirely eliminate, the plate effectiveness infacilitating the instrument's grasp of the suture.

The loading element can be configured to facilitate loading of the plateinto the instrument, e.g., into the end effector of the instrument, andthereby help make the plate less difficult to load into the instrument.In other words, the loading element may make the plate easier to loadinto the instrument regardless of the plate's size, may prevent theplate from deforming during its loading into the instrument, and/or maybe configured to facilitate confirmation of the plate's proper loadinginto the instrument. The loading element can have a variety of sizes,shapes, and configurations, as discussed further below.

FIGS. 1 and 2 illustrate one embodiment of a surgical instrument 10configured to facilitate passage of a suture through tissue. As in thisillustrated embodiment, the instrument 10 can include a proximal handleportion 12, an elongate shaft 14 extending distally from the handleportion 12, and an end effector 16 coupled to a distal end of the shaft14. The end effector 16 can include a first or upper jaw 18 a and asecond or lower jaw 18 b configured to grasp tissue therebetween. Thefirst jaw 18 a is configured to move relative to the lower jaw 18 b andthe shaft 14 to facilitate the tissue grasping. In other embodiments, aswill be appreciated by a person skilled in the art, the lower jaw 18 bcan be configured to move relative to the upper jaw 18 a and the shaft14, or both of the upper and lower jaws 18 a, 18 b can be configured tomove relative to the shaft 14.

The instrument 10 can be configured to have a needle 20 removably andreplaceably seated therein. As shown in this illustrated embodiment, theneedle 20 can include a proximal needle body 22 that has a slotteddistal end 24 and a flat bendable extension 26 that is within and iswelded to the slotted distal end 24 of the needle body 22. The needle 20can be configured to move relative to the shaft 14 and the end effector16 to facilitate passage of a suture (not shown) through tissue. Variousembodiments of using a needle loaded into a surgical instrument tofacilitate passage of a suture through tissue are further described inU.S. Pat. No. 8,540,732 entitled “Suturing Apparatus And Method” filedDec. 17, 2010, which is hereby incorporated by reference in itsentirety.

The handle portion 12 can have a variety of configurations. As shown inthis illustrated embodiment, the handle portion 12 can include a jawclosure trigger 28, a needle movement trigger 30, a stationary handle32, and a housing 34. The stationary handle 32 can be part of thehousing 34, as shown. The jaw closure trigger 28 can be configured tomove relative to the stationary handle 32 to open and close the endeffector 16 (e.g., to move the upper jaw 18 a of the end effector 16relative to the lower jaw 18 b). The needle movement trigger 30 can beconfigured to move the needle 20 relative to the shaft 14 and the endeffector 16. The housing 34 can house various components thereinconfigured to facilitate the opening and closing of the end effector 16and/or to facilitate the movement of the needle 20. The handle portion12 is generally configured and usable similar to handle portions ofsurgical instruments described in previously mentioned U.S. Pat. No.8,540,732 entitled “Suturing Apparatus And Method” filed Dec. 17, 2010.

The instrument 10 is generally configured and usable similar to surgicalinstruments configured to facilitate passage of a suture through tissueusing a needle that are described in previously mentioned U.S. Pat. No.8,540,732 entitled “Suturing Apparatus And Method” filed Dec. 17, 2010.In the illustrated embodiment of FIGS. 1 and 2, however, the endeffector 16 is configured to seat a retainer plate (not shown) therein.Namely, the upper jaw 18 a is configured to seat a retainer platetherein. The upper jaw 18 a can have a variety of configurations.

In general, the upper jaw 18 a can be configured to removably andreplaceably seat the retainer plate therein. The plate may thus beremoved from the instrument 10 and replaced after its use in a surgicalprocedure, e.g., after being used in connection with capturing a suture.The plate may become deformed during its use, as discussed furtherbelow, so as to reduce its effectiveness in any subsequent use tocapture a suture. Thus, replacement of the plate may allow theinstrument 10 to be re-used with other plates in the same surgicalprocedure and/or in subsequent surgical procedures. If the instrument 10is reconditioned after its use for reuse in another surgical procedure,it may be difficult for the plate and/or parts of the instrument 10 nearthe plate seated therein to be fully cleaned after use of the plate andthe instrument. The removability of the plate may facilitate properreconditioning of the instrument 10 since the used plate may be removedprior to the reconditioning.

A surgical instrument such as the instrument 10 can be provided as partof a kit that includes a plurality of retainer plates each configured tobe removably and replaceably loaded into the instrument. The kit maymake it easier to use multiple plates during the course of a singlesurgical procedure by making the plates easily accessible. Each of theplates included in the kit can be the same as one another or any one ormore of the plates can differ from any one or more of the other plates.The plates being the same as one another may provide predictability to auser (e.g., a surgeon) and/or may speed plate loading since no choiceneed be made between the identical ones of the plates. The plates notall being the same as one anther may allow the user to choose aparticular type of plate that the user may prefer in general and/or forthe particular surgical procedure to be performed. Different types ofplates are discussed further below. The kit can also include a singleneedle (e.g., the needle 20) or can include a plurality of needles,which may or may not include the illustrated needle 20. Similar to thatdiscussed above regarding the kit including multiple plates, themultiple needles included in the kit can all be the same as one another,or any one or more of the needles can differ from any one or more of theother needles. The kit can also include a loading element. While the kitmay include multiple loading elements, only a single loading element isneeded in the kit since the loading element can be configured to bereused to sequentially load plates into the instrument, as discussedfurther below.

FIGS. 3 and 4 illustrate one embodiment of a retainer plate 36configured to facilitate manipulation of a suture. As discussed herein,the plate 36 can be configured to be removably and replaceably seated ina surgical instrument (e.g., in an upper jaw of an end effector of theinstrument). The plate 36 can have a variety of sizes, shapes, andconfigurations.

The plate 36 can be formed from a variety of materials. The material(s)forming the plate 36 can be selected to allow the plate 36 to deformwithout breaking, e.g., to bend or flex without breaking. In anexemplary embodiment, the material(s) can be biocompatible. In anexemplary embodiment, the plate 36 can be metallic, e.g., formed fromone or more metals. The plate 36 being metallic may provide structuralstability to the plate 36 while allowing the plate 36 to deform withoutbreaking.

The plate 36 can be disposable. In other words, after the plate 36 isremoved from a surgical instrument in which the plate 36 is seated, theplate 36 can be disposed of according to applicable standards ofdiscarding used medical devices or elements thereof. The plate 36 beingdisposable may help prevent the adverse effects of metal fatigue thatcan arise from reuse of a metallic plate. In an exemplary embodiment,the plate 36 can be disposed of after a single use, which may preventany deformation of the plate 36 that occurs during use from adverselyaffecting subsequent use of the plate 36 and/or may prevent the adverseeffects of metal fatigue that can arise from reuse of a metallic platesince such adverse effects typically do not arise during a single use.

As shown, the plate 36 can be a planar member having substantially flattop and bottom surfaces 38 a, 38 b. A person skilled in the art willappreciate that a surface may not be precisely flat but nevertheless beconsidered to be substantially flat due to, e.g., manufacturingtolerances, a texture thereon, and/or tolerances in measurement devices.The plate 36 being planar may facilitate loading of the plate 36 into asurgical instrument, which is described further below.

The plate 36 can include a pair of arms 42 a, 42 b at a proximal end 40of the plate 36. The arms 42 a, 42 b can extend longitudinally, asshown. The arms 42 a, 42 b can taper inwardly, e.g., toward alongitudinal axis A of the plate 36, so as to be located within amaximum width 36 w defined by the plate 36. The arms 42 a, 42 b candefine an opening 44 therebetween. The arms 42 a, 42 b can be configuredto be laterally movable, as shown by arrow R in FIG. 3. The opening 44between the arms 42 a, 42 b provides room for the arms 42 a, 42 b tolaterally move. The arms 42 a, 42 b being laterally movable mayfacilitate the loading of the plate 36 into a surgical instrument, asdiscussed further below. In general, the arms 42 a, 42 b can beconfigured to lock the plate 36 in position relative to the surgicalinstrument.

The arms 42 a, 42 b can have a normal or default position, which isshown in FIGS. 3 and 4. The arms 42 a, 42 b can each be configured tomove laterally from the default position and dynamically return to thedefault position, similar to a spring, absent an external force appliedthereto holding one or both of the arms 42 a, 42 b in a position otherthan the default position.

The arms 42 a, 42 b at their respective proximal ends can each have aprotrusion 43 a, 43 b extending radially outward therefrom. Theprotrusions 43 a, 43 b can be configured to facilitate seating of theplate 36 in an end effector of a surgical instrument, as discussedfurther below.

As shown, a distal-most surface 46 of the plate 36 can be linear, e.g.,straight. In other embodiments, a retainer plate's distal-most surfacecan be non-linear. In general, the non-linear distal-most surface can beconfigured as a suture retention feature. The plate's distal-mostsurface being non-linear may help the plate grip a suture being capturedby the surgical instrument in which the plate is loaded, as discussedfurther below, and thereby help retain the suture.

The plate 36 can have a variety of shapes. As shown, the plate 36 canhave a substantially rectangular distal portion from which the arms 42a, 42 b extend in a proximal direction.

FIG. 5 illustrates one embodiment of a retainer plate 48 having anon-linear distal-most surface 50. The plate 48 can otherwise beconfigured and used similar to the plate 36, e.g., can have asubstantially flat top surface 52 and a substantially flat bottomsurfaces (obscured in FIG. 5), can be metallic, can include a pair arms54 a, 54 b defining an opening 56 therebetween, etc. The distal-mostsurface 50 in this illustrated embodiment is a wavy surface defining aplurality of suture-seating grooves 58 therein and a plurality of teeth60. The grooves 58 can each be configured to seat a suture therein,e.g., a suture being captured by the instrument in which the plate 48 isseated, and/or to “bite” into the suture. The wavy surface definescurved shapes of the grooves 58 and the teeth 60. The curved shape ofthe grooves 58 and the teeth 60 may help prevent a suture from snagging,tearing, or otherwise becoming damaged by the plate's distal-mostsurface 50. Sutures typically have circular cross-sections, so thecurved shape of each of the grooves 58 may match the shape of a suture,which may help urge the suture into the grooves 58.

FIG. 6 illustrates another embodiment of a retainer plate 62 having anon-linear distal-most surface 64. The plate 62 can otherwise beconfigured and used similar to the plate 36. In this illustratedembodiment, the distal-most surface 64 has a triangular wave shapedefining a plurality of triangular grooves 66 and a plurality oftriangular teeth 68. The triangular shape of the grooves 66 may helpcrimp a suture therein, since sutures typically have a circularcross-sectional shape. FIG. 6A shows one embodiment of a suture 70seated in two of the grooves 66 and straddling one of the teeth 68. Inother words, the suture 70 is looped over one of the teeth 68. Suchseating of the suture 70 can be how the suture 70 is positioned relativeto the plate 62 when the suture 70 is captured by an instrument in whichthe plate 62 is seated. Alternatively, one or more of the teeth 68 can“bite” into the suture 70 to help retain the suture.

FIG. 7 illustrates another embodiment of a retainer plate 72 having anon-linear distal-most surface 74. The plate 72 can otherwise beconfigured and used similar to the plate 36. In this illustratedembodiment, the distal-most surface 74 has a square wave shape defininga plurality of square grooves 76 and a plurality of square teeth 78. Thesquare shape of the grooves 76 may help grasp a suture similar to thetriangular teeth 68.

In addition to or in alternative to a retainer plate having a non-lineardistal-most surface configured as a suture retention feature, the platecan include one or more other types of suture retention features.Examples of other suture retention features include a textured surface,a surface finish, and a checkered surface.

FIGS. 8 and 9 illustrate a distal portion of one embodiment of asurgical instrument 80 configured to facilitate passage of a suturethrough tissue and including an end effector 84 configured to seat aretainer plate (not shown) therein. The instrument 80 can generally beconfigured and used similar to the instrument 10 of FIG. 1 and othersurgical instruments described herein, e.g., include a handle portion(not shown), include an elongate shaft 82 having the end effector 84 ata distal end thereof, be configured to removably and replaceably seat aneedle (not shown), etc. In this illustrated embodiment, the endeffector 84 includes upper and lower jaws 86 a, 86 b, with the upper jaw86 a being configured to move relative to the lower jaw 86 b and theelongate shaft 82. FIG. 8 shows the jaws 86 a, 86 b in an open position,and FIG. 9 shows the jaws 86 a, 86 b in a closed position.

The upper jaw 86 a, which is shown as a standalone element in FIG. 10,can be configured to removably and replaceably seat the retainer platetherein. An outer or upper side of the upper jaw 86 a can be configuredto seat the plate in a cavity 88 formed in the upper side. The upperside of the upper jaw 86 a being configured to seat the plate mayfacilitate visualization of the plate within the upper jaw 86 a, whichmay help a user visually confirm proper loading of the plate into theend effector 84 since the plate may be visible in the end effector 84regardless of whether the jaws are open or closed and regardless ofwhether any material (e.g., tissue, etc.) is positioned between thejaws. The cavity 88 can define a recessed portion of the upper jaw 86 aconfigured to seat the plate therein. The cavity 88 can extendlongitudinally along the upper jaw 86 a and hence longitudinally alongthe end effector 84, with reference to a longitudinal axis A2 of the endeffector 84. The upper jaw 86 a can thus be disposed between the plateand the lower jaw 86 b when the plate is seated in the upper jaw 86 a.The cavity 88 can include a bottom surface 90 configured to seat theplate thereon. The bottom surface 90 can be substantially flat andtherefore correspond in shape to a substantially flat surface of theplate. The substantially flat surface of the plate, e.g., one ofsubstantially flat top and bottom surfaces of the plate, can thus beconfigured to rest on the substantially flat bottom surface 90.

The cavity 88 can have a shape corresponding to a shape of a retainerplate configured to be seated in the upper jaw 86 a. As shown, thecavity 88 has a shape corresponding to shapes of the plate 36 of FIG. 3and the plate 48 of FIG. 5. Namely, the cavity 88 has a substantiallyrectangular shape in a distal portion 92 d thereof and has a taperedproximal portion 92 t that tapers proximally to a smaller width. Thedistal portion 92 d of the cavity 88 can be configured to seat asubstantially rectangular portion of the plate, and the tapered proximalportion 92 t of the cavity 88 can be configured to seat the plate'stapering arms therein. A proximal-most portion 92 p of the cavity 88proximal to the tapered proximal portion 92 t can expand from a minimumwidth of the cavity 88 define by the tapered proximal portion 92 t. Theproximal-most portion 92 p of the cavity 88 can be configured to seatthe proximal-most ends of the plate's arms therein. The proximal-mostportion 92 p of the cavity 88 can thus be configured to seat protrusionsat proximal ends of the plate's arms therein. The cavity 88 having agreater width in its proximal-most portion 92 p than at least at theproximal end of the tapered proximal portion 92 t of the cavity 88 canfacilitate locking of the plate therein. The protrusions of the plate'sarms can be configured to be seated in the proximal-most portion 92 p ofthe cavity 88, which may help hold the plate within the cavity 88 at afixed longitudinal position. In other words, the arms' protrusions andthe upper jaw 86 a can cooperate to hold the plate within the upper jaw86 a at a fixed axial position. The plate's arms can be configured to becompressed radially inward from the arms' normal or default positionwithin the cavity 88 such that the arms are dynamically urged radiallyoutward within the cavity 88. This radially outward directed force mayhelp hold the plate within the cavity 88, and hence within the upper jaw86 a and the end effector 84, and help prevent the plate from movinglaterally within the cavity 88 once seated therein.

The upper jaw 86 a can include a plate-retaining feature configured tohelp retain the plate within the upper jaw 86 a, e.g., within the upperjaw's cavity 88. As shown, the plate-retaining feature can includeretention tabs 94 a, 94 b. The illustrated upper jaw 86 a includes tworetention tabs 94 a, 94 b, but an upper jaw can include another numberof plate-retaining features (e.g., one, three, four, etc.). Theretention tabs 94 a, 94 b can extend radially inward, e.g., toward theend effector's longitudinal axis A2, from a top surface of the upper jaw86 a, e.g., from an upper rim or perimeter 96 thereof, so as to bepositioned above the cavity 88. Thus, the plate seated within the cavity88 will be below the retention tabs 94 a, 94 b. The retention tabs 94 a,94 b can thus be configured to help retain the plate within the cavity88 by preventing upward movement of the plate within the cavity 88 atleast at a location of the tabs 94 a, 94 b along the longitudinal axisA2. The retention tabs 94 a, 94 b can be located adjacent the taperedproximal portion 92 t of the cavity 88, e.g., within the taperedproximal portion 92 t, at a junction between the tapered proximalportion 92 t and the distal portion 92 d, or within the distal portion92 d in a proximal region thereof. The plate seated in the upper jaw 86a may thus deform without being limited by the retention tabs 94 a, 94b, as discussed further below.

The upper rim 96 of the upper jaw 86 a can be non-continuous so as tonot fully extend around the upper jaw 86 a. In other words, the upperjaw 86 a can have a gap 98 (also referred to herein as a “window”)formed therein. The gap 98 may facilitate visualization of a platewithin the upper jaw 86 a, which may help a user visually confirm properloading of the plate into the end effector 84 since the plate may bevisible in the end effector 84 regardless of whether the jaws are openor closed and regardless of whether any material (e.g., tissue, etc.) ispositioned between the jaws. The gap 98 can be in communication with thecavity 88 such that material such as a suture can pass through the gap98 and into the cavity 88 and/or from the cavity 88 and out of the gap98. This passage may facilitate grasping of a suture by the end effector84, as discussed further below. The bottom surface 90 of the cavity 88can exist only in a proximal portion of the upper jaw 86 a, as shown,such that an area 100 distal to the bottom surface 90 is open adjacentto the gap 98. The open area 100 may also facilitate grasping of asuture by the end effector 84. The gap 98 can be formed in a side of theupper jaw 86 a between its proximal and distal ends, as shown, tofacilitate side-removal of a suture from the upper jaw 86 a, e.g.,removal of the suture transversely (e.g., perpendicular or at anothernon-right or non-zero angle) to the end effector's longitudinal axis A2.A person skilled in the art will appreciate that the direction may notbe precisely perpendicular but nevertheless be considered to besubstantially perpendicular due to, e.g., manufacturing tolerances, atexture thereon, and/or tolerances in measurement devices.

The upper jaw 86 a can include a suture-retaining feature configured tofacilitate retention of a suture by the end effector 84. As shown, thesuture-retaining feature can include a non-linear interior surface 102,e.g., an interior-facing surface, at a distal end of the upper jaw 86 a.The non-linear interior surface 102 can generally be configured similarto a non-linear distal-most surface of a plate, such as the non-lineardistal-most surfaces 50, 64, 74 discussed above, and can include aplurality of grooves and a plurality of teeth. The upper jaw'snon-linear interior surface 102 has a wavy shape similar to the wavyshape of the non-linear distal-most surface 50 of FIG. 5 discussedabove. The non-linear interior surface 102 can be recessed within theupper jaw 86 a, as shown. This recessing can allow the non-linearinterior surface 102 to be aligned with a distal-most surface of theplate seated in the cavity 88. The plate's non-linear distal-mostsurface and the upper jaw's non-linear interior surface 102 can thus beconfigured to grip a suture therebetween to help the end effector 84securely hold the suture. In other words, the upper jaw'ssuture-retaining feature 102 can be configured to cooperate with adistal-most surface of the plate seated in the cavity 88 to facilitatethe surgical instrument's grasping of a suture.

By way of example, FIG. 11 shows the plate 36 of FIG. 3 seated in thecavity 88 of the upper jaw 86 a of FIG. 8 with the end effector 84 in anopen position and grasping a suture 104 passed through material 106representative of tissue. The end effector 84 can, however, seat othertypes of plates, e.g., a plate similar to the plate 36 but formed from adifferent material, the plate 48 of FIG. 5, etc. The suture 104 isextending through the opening 100 and is gripped between the plate'sdistal-most surface 46 and the upper jaw's non-linear interior surface102. As discussed further below, the suture 104 grasped by the endeffector 84 can be pulled by the instrument away from the material 106,e.g., away from tissue, through which the suture 104 extends. The suture104 can then be moved through the gap 98, as shown in FIG. 12, to beremoved from the end effector 84, as shown in FIG. 13.

FIG. 14 illustrates a distal portion of another embodiment of a surgicalinstrument 106 configured to facilitate passage of a suture throughtissue and including an end effector 108 configured to seat a retainerplate therein. The plate 36 of FIG. 3 is shown seated in the endeffector 108 that includes upper and lower jaws 112 a, 112 b, but othertypes of plates can be seated therein, e.g., a plate similar to theplate 36 but formed from a different material, the plate 48 of FIG. 5,etc. The instrument 106 can generally be configured and used similar tothe instrument 10 of FIG. 1 and other surgical instruments describedherein, e.g., include a handle portion (not shown), include an elongateshaft 110 having the end effector 108 at a distal end thereof, beconfigured to removably and replaceably seat a needle (not shown), etc.The upper jaw 112 a can generally be configured and used similar to theupper jaw 86 a of FIG. 8 and other upper jaws described herein. In thisillustrated embodiment, the upper jaw 112 a is configured to moverelative to the lower jaw 112 b and the elongate shaft 110. FIG. 14shows the jaws 112 a, 112 b in a closed position. An arrow R2 in FIG. 14indicates a direction in which a suture (not shown) grasped by the endeffector 108 may be moved through a gap 114 formed in a side of theupper jaw 112 a.

A size of a cavity (obscured in FIG. 14) formed in the upper jaw 112 aand a size of plate to be seated in the upper jaw 112 a can be chosen sothat no clearance space exists between the upper's jaw'ssuture-retaining feature, e.g., a linear or non-linear interior-facingsurface at a distal end the upper jaw 112 a. The interior-facing surfaceat the distal end the upper jaw 112 a is obscured in FIG. 14 because noclearance space exists between this surface and the plate's distal-mostsurface 46. In other words, the plate 36 overlaps the suture-retainingfeature, e.g., the interior-facing surface at the distal end the upperjaw 112 a. The lack of clearance space between the upper jaw'sinterior-facing surface and the plate's distal-most surface 46 mayfacilitate grasping of a suture therebetween. As mentioned above, theplate 36 can be configured to deform. This deformation can be in anupward direction, with retention tabs 116 a, 116 b of the upper jaw 112a helping to keep the plate 36 retained in the upper jaw 112 a, asdiscussed above. A suture captured by the instrument 106 can be“trapped” between the deformed plate's distal-most surface 46 and theupper jaw's interior-facing surface, thereby facilitating theinstrument's grasp of the suture. Additionally, the plate's lack ofdistal-most surface 46 being linear, as opposed to be non-linear, maynot affect the grasp of the suture due to the lack of clearance space.If clearance space does exist between the upper jaw's interior-facingsurface and a distal-most surface of a plate seated in the upper jaw 112a, the plate's distal-most surface being non-linear can be configured tofacilitate suture grasping, as discussed above, such that the lack ofclearance space may not affect the grasp of the suture.

FIG. 15 illustrates a distal portion of another embodiment of a surgicalinstrument 117 configured to facilitate passage of a suture throughtissue and including an end effector 118 configured to seat a retainerplate therein. The plate 36 of FIG. 3 is shown seated in the endeffector 118 that includes upper and lower jaws 120 a, 120 b, but othertypes of plates can be seated therein, e.g., a plate similar to theplate 36 but formed from a different material, the plate 48 of FIG. 5,etc. The instrument 117 is like the instrument 106 of FIG. 14 exceptthat the instrument 117 does not include a sidewall gap like the gap114. Instead, an upper rim 122 of the upper jaw 120 is continuous so asto extending fully around the upper jaw 120 a.

FIG. 15 also illustrates an arrow R3 pointing proximally and indicatinga direction of loading of the plate 36 into the end effector 118, e.g.,into the upper jaw 120 a. Such loading can be accomplished using aloading element, as discussed further below.

FIGS. 16-19 illustrate another embodiment of an upper jaw 124 aconfigured to seat a retainer plate (not shown) therein. FIGS. 16 and 17also illustrate a bottom jaw 124 b of an end effector 126 that alsoincludes the upper jaw 124 a. The end effector 126 can generally beconfigured and used similar to the end effector 16 of FIG. 1 and otherend effectors described herein. The end effector 126 can thus be part ofan instrument that can be configured and used similar to the instrument10 of FIG. 1 and other surgical instruments described herein, e.g.,include a handle portion (not shown), include an elongate shaft (notshown) having the end effector 126 at a distal end thereof, beconfigured to removably and replaceably seat a needle (not shown), etc.The end effector 126 is shown in a closed position in FIG. 16 and in anopen position in FIG. 17. For clarity of illustration, only distalportions of the end effector 126 are shown in FIGS. 16 and 17, and onlydistal portions of the upper jaw 124 a are shown in FIGS. 18 and 19.

The upper jaw 124 a can generally be configured and used similar to theupper jaw 86 a of FIG. 8 and other upper jaws described herein. However,in this illustrated embodiment, the upper jaw 124 a includes a secondarysuture-retaining feature in addition to the suture-retaining feature ofa non-linear interior surface 128 at a distal end of the upper jaw 124a. In general, the secondary suture-retaining feature can be configuredto facilitate retention of a suture by the end effector 126. Thesecondary suture-retaining feature in this illustrated embodimentincludes a bucktooth 130. As shown in FIGS. 16 and 17, the bucktooth 130can extend downwardly toward the bottom jaw 124 b and can be located ata distal-most end of the upper jaw 124 a. The bucktooth 130 can thusdefine a downwardly protruding portion of the upper jaw 124 a at thedistal-most end thereof. The bottom jaw 124 b can include asuture-engaging surface 132 facing the bucktooth 130, e.g., an upwardlyfacing surface that faces the downwardly-extending bucktooth 130. Anarea 134 between the suture-engaging surface 132 and the bucktooth 130can be an area in which a suture grasped by the end effector 126 isclamped or pinched between the suture-engaging surface 132 and thebucktooth 130 so as to provide an increased retention force to thesuture over the retention force provided by the non-linear interiorsurface 128 and the retention plate (not shown) seated in the upper jaw124 a. This clamping or pinching may help the end effector 126, andhence the surgical instrument of which it is part, securely hold ontothe suture, such as during pull-out of the suture from a patient's body.The upper jaw 124 a includes a single bucktooth 130, which may helpensure that the suture grasped by the end effector 126 is clamped orpinched between the bucktooth 130 and the suture-engaging surface 132,as opposed to being more loosely disposed between different buckteeth.

Also unlike the upper jaw 86 a of FIG. 8, in this illustratedembodiment, the upper jaw 124 a includes a stepped area configured toprevent downward deformation of a retention plate seated in the upperjaw 124 a, e.g., within a cavity 136 formed in an upper side of theupper jaw 124 a. The stepped area in this illustrated embodimentincludes two stepped areas 138 a, 138 b on opposed left and right sidesof the upper jaw 124 a, but an upper jaw can include another number ofstepped areas (e.g., one, three, four, etc.). The stepped area 138 a,138 b can be stepped downwardly from the upper jaw's non-linear interiorsurface 128, as shown. The stepped area 138 a, 138 b can thus beconfigured as a stop surface that prevents the plate seated in the upperjaw 124 a from deforming downwardly beyond a certain point defined bythe stepped area 138 a, 138 b. The stepped area 138 a, 138 b may thushelp maintain relatively close vertical distance between the plate'sdistal-most surface and the upper jaw's non-linear interior surface 128,which as discussed herein can cooperate together to grasp a suturetherebetween. The stepped area 138 a, 138 b can be located in a distalportion of the upper jaw 124 a and thereby be configured to seat adistal portion of the plate. The stepped area 138 a, 138 b can thus beconfigured to prevent downward deformation of a distal portion of theplate seated in the upper jaw 124 a. A bottom surface 140 of the cavity136 on which the plate is seated can be similarly configured to preventdownward deformation of a proximal portion the plate seated in the upperjaw 124 a.

In at least some embodiments, a retention plate can be pre-loaded intoan end effector of a surgical instrument, e.g., loaded therein duringmanufacturing, such that a user receives the instrument with the plateloaded therein. The plate may thus be properly loaded into theinstrument since it is loaded therein according to manufacturingspecifications and/or the plate may be less likely to be dropped or lostwhen removing the plate from its packaging. The plate can be removablyand replaceably pre-loaded into the end effector such that the plate canbe removed from the end effector by a user (e.g., a surgeon, a surgicalassistant, a medical technician, etc.) and replaced therein with asecond plate. The second plate can then be removed from the end effectorby the user or another user and replaced therein with a third plate, andso on. However, as discussed above, it may be difficult to load thesecond plate and any subsequent plates into the instrument, e.g., intothe instrument's end effector, for one or more reasons. Similarly, inembodiments in which an end effector of a surgical instrument does nothave a retention plate pre-loaded therein such that a first plate loadedinto the end effector is manually loaded therein by a user, it may bedifficult to load the first plate and any subsequently loaded platesinto the instrument, e.g., into the instrument's end effector, for oneor more reasons.

As mentioned above, a loading element can be configured to facilitatethe loading of a retention plate into a surgical instrument. FIGS. 20and 21 illustrate one embodiment of a loading element 142 configured tofacilitate loading of a plate into a surgical instrument (not shown)configured to pass a suture through tissue. The loader 142 is shown inFIG. 20 with the plate 36 of FIG. 3 and is discussed below relativethereto, but the loader 142 can be used with this plate 36 and/or otherplates, e.g., a plate similar to the plate 36 but formed from adifferent material, the plate 48 of FIG. 5, the plate 72 of FIG. 7, etc.The loader 142 can be configured to have the plate 36 loaded therein fordelivery of the plate 36 to a surgical instrument. The plate 36 can bepre-loaded therein, e.g., during manufacturing. The plate 36 may thus beproperly loaded into the loader 142 since it is loaded therein accordingto manufacturing specifications. Alternatively, the loader 142 may nothave the plate 36 pre-loaded therein, and the plate 36 can be manuallyloaded into the loader 142 by a user. The user may thus select bypreference a particular plate.

The loader 142 can be disposable. In other words, after the loader 142is used to load the plate 36 into a surgical instrument, the loader 142can be disposed of according to applicable standards of discarding usedmedical devices or elements thereof. The loader 142 being disposable maylimit improper loading of a retention plate therein, and hence improperdelivery of the plate to a surgical instrument, since the loader 142 canbe pre-loaded with a plate and disposed after the one loading of the oneplate into a surgical instrument.

The loader 142 can include a cavity 144 formed in a bottom side thereof,as shown in FIG. 21. The cavity 144 can be configured to seat the plate36 therein and to receive at least a portion of an end effector thereinsimultaneously with the plate 36 being seated therein. The portion ofthe end effector receivable in the cavity 144 can include at least aportion of the end effector, e.g., an upper jaw thereof, configured toseat the plate 36 therein. As discussed in further detail below,movement of the loader 142 relative to the end effector at leastpartially seated therein (or movement of the end effector relative tothe loader 142 having the end effector at least partially seatedtherein) can cause the plate 36 seated in the loader 142 to move frombeing seated in the loader 142 to being seated in the end effector. Theplate 36 may thus be easily loaded into the end effector using theloader 142. No loading accessories other than the single loader 142 maybe needed to accomplish the loading of the plate 36 into the endeffector, thereby reducing equipment costs and/or resulting in a simpleplate-loading procedure.

A proximal end 154 of the loader 142 can have an opening 156 formedtherethrough that is in communication with the cavity 144. The opening156 can be configured to have a portion of a surgical instrumentextending therethrough when at least a portion of the surgicalinstrument is seated within the cavity 144, e.g., when at least aportion of the instrument's upper jaw is seated within the cavity 144 toreceive the plate 36 therein.

The cavity 144 can have a lower surface 146 and opposed side surfaces148 a, 148 b. A distance between the opposed side surfaces 148 a, 148 bcan be configured to allow a clearance fir between the loader 142 andthe portion of the end effector (e.g., upper jaw) to be positionedwithin the cavity 144 to have the plate 36 loaded therein. A distancebetween the opposed side surfaces 148 a, 148 b can thus be slightlylarger than a width of an upper jaw of an end effector. The lowersurface 146 of the cavity 144 can be configured to seat thereon an uppersurface of an end effector's upper jaw having at least a portion thereofpositioned within the cavity 144. The upper surface of the upper jaw andthe lower surface 146 of the cavity 144 can be slidably engaged.Depending on a longitudinal length of the end effector's upper jaw, theupper jaw may not be seated on an entirety of the lower surface 146.

Below the cavity's lower surface 146, the loader 142 can include aplate-seating surface 150 configured to seat the plate 36 thereon. Theplate-seating surface 150 can be angled in a distal direction toward adistal end 152 of the loader 142. The plate 36, when seated on theplate-seating surface 150, can thus be positioned within the cavity 144at an angle, as shown in FIG. 22. A longitudinal axis A3 of the loader142 and the longitudinal axis A of the plate 36 can thus be at an angleα. The angle α can have any of a variety of non-zero values greater than0° and less than 90°. The plate-seating surface 150 can thus also haveany of a variety of non-zero values greater than 0° and less than 90°,since the angle of the plate-seating surface 150 defines the angle α.The plate 36 being angled in the loader 142 prior to the plate's loadinginto an end effector using the loader 142 may help the plate 36 bepositioned within an upper jaw of an end effector under retention tabsthereof, instead of above the retention tabs, such that the retentiontabs can be effective to retain the plate 36 within the upper jaw.

The loader 142 can include a crossbar 158 that is distal to theplate-seating surface 150. A portion of the lower surface 146 of thecavity 144 can define a portion of the crossbar 158, as shown in FIGS.21 and 22. The crossbar 158 can extend substantially perpendicular tothe longitudinal axis A3 of the loader 142, and hence to thelongitudinal axis A of the plate 36 when the plate 36 is seated in thecavity 144 of the loader 142. A person skilled in the art willappreciate that the extension may not be precisely perpendicular butnevertheless be considered to be substantially perpendicular due to,e.g., manufacturing tolerances and/or tolerances in measurement devices.The crossbar 158 can be configured as a support to help hold the plate36 in the loader 142 prior to the plate's loading into an end effector.

The loader 142 can include a window 160 a, 160 b formed in a top sidethereof. The window 160 a, 160 b in this illustrated embodiment includestwo windows. The window 160 a, 160 b can be in communication with thecavity 144, thereby allowing visualization of the cavity 144 through thewindow 160 a, 160 b. If matter is positioned within the cavity 144, suchas the plate 36 and/or a portion of an end effector, the matter can bevisualized through the window 160 a, 160 b. The window 160 a, 160 b maythus facilitate proper loading of the plate 36 into an end effectorsince the plate 36 and/or the end effector can be visually inspectedwhen located within the loader 142.

The loader 142 can include a grip mechanism 162 configured to facilitatemanual handling of the loader 142 by improving grip of the loader 142.The grip mechanism 162 in this illustrated embodiment includes raisedexternal surface features on opposed sides of the loader 142. Otherexamples of grip mechanisms include a textured surface and fingerdepressions. The loader 142 can include any number of grip mechanisms.Curved sides of the loader 142 between the loader's proximal and distalends 154, 152, as shown, may facilitate the loader 142 being held byfingers at the curved sides.

FIG. 22 also shows the upper jaw 120 a of the end effector 118 of FIG.15 positioned within the cavity 144 prior to the plate 36 having movedto be seated in the upper jaw 120 a. The loader 142 may be used withthis end effector 118 and/or other end effectors, e.g., the end effector84 of FIG. 8, the end effector 126 of FIG. 16, etc.

FIG. 23 illustrates another embodiment of a loading element 164configured to facilitate loading of a plate 36 into a surgicalinstrument 117 configured to pass a suture through tissue. The loader164 is shown with the plate 36 of FIG. 3 and the instrument 117 of FIG.15 and is discussed below relative thereto, but the loader 164 may beused with this plate 36 and/or other plates, e.g., a plate similar tothe plate 36 but formed from a different material, the plate 48 of FIG.5, the plate 72 of FIG. 7, etc., and may be used with this instrument117 and/or other instruments, e.g., the instrument 80 of FIG. 8, etc.The loader 164 can generally be configured and used similar to theloader 142 of FIG. 20, e.g., include a window 166 a, 166 b, include agrip mechanism 168, include a cavity 170 therein, include a crossbar(obscured in FIG. 23), etc. In this illustrated embodiment, the loader164 has a different overall shape than the loader 142 of FIG. 20. Alsoin this illustrated embodiment, the cavity 170 has an open distal end170 d, whereas the cavity 144 of the loader 142 of FIG. 20 has a closeddistal end. The open distal end 170 d may facilitate visualization ofthe plate 36 and/or the end effector 118 within the cavity 170 andthereby help a user evaluate proper loading of the plate 36 into the endeffector 118, e.g., into the upper jaw 120 a.

FIGS. 24-28 illustrate a method of using the loader 142 to load theplate 36 into another embodiment of a surgical instrument 172 configuredto pass a suture through tissue. The instrument 172 can generally beconfigured and used similar to the instrument 10 of FIG. 1 and othersurgical instruments described herein, e.g., include a handle portion(not shown), include an elongate shaft 174 having an end effector 176 ata distal end thereof, be configured to removably and replaceably seat aneedle (not shown), etc. In this illustrated embodiment, the endeffector 176 includes upper and lower jaws 178 a, 178 b, with the upperjaw 178 a being configured to move relative to the lower jaw 178 b andthe elongate shaft 174. As mentioned above, the loader 142 can be usedto load other plates into this instrument 172 and/or into other surgicalinstruments. Also, the loader 164 of FIG. 23 and other similarembodiments of loaders described herein can be used in a similar method.

As shown in FIG. 24, the loader 142 having the plate 36 seated in thecavity 144 thereof (the plate 36 and the cavity 144 are obscured in FIG.24) can be advanced in a first direction, indicated by arrow D1,relative to the end effector 176 at the distal end of the instrument172. The advancement can be due to the loader 142 moving relative to theend effector 176 or the end effector 176 moving relative to the loader142. The first direction D1 is substantially perpendicular to theloader's longitudinal axis A3 and is substantially perpendicular to alongitudinal axis A4 of the upper jaw 178 a. The upper jaw'slongitudinal axis A4 is substantially parallel to a longitudinal axis A5of the shaft 174, as shown in FIG. 24, when the end effector 176 is in aclosed position. In FIG. 24 the end effector 176 is in the closedposition, e.g., the jaws 178 a, 178 b are closed. A person skilled inthe art will appreciate that the first direction D1 may not be preciselyperpendicular to the axis A4 but nevertheless be considered to besubstantially perpendicular due to, e.g., tolerances in measurementdevices.

The loader 142 can be advanced in the first direction D1 toward the endeffector 176 such that a distal tip 180 of the upper jaw 178 a is seatedin the cavity 144, since the plate 36 will be seated in the upper jaw178 a. A distal tip 182 of the bottom jaw 178 b can also be seated inthe cavity 144 such that a distal tip of the end effector 176 is seatedin the cavity 144. An amount of the upper jaw's distal tip 180positioned in the cavity 144 (and an amount of the bottom jaw's distaltip 182 if also positioned in the cavity 144) can vary. In general,enough of the upper jaw's distal tip 180 can be positioned in the cavity144 such that some of the upper jaw 178 a is within the cavity 144 andsome of the upper jaw 178 a is outside the cavity 144 with a portion ofthe upper jaw 178 a being within the opening 156. Enough of the bottomjaw's distal tip 182 can be similarly positioned.

FIGS. 25A and 25B show the distal tips 180, 182 of the upper and lowerjaws 178 a, 178 b seated in the cavity 144. As shown, the arms 42 a, 42b of the plate 36 can be located within a distal portion 184 d of acavity 186 formed in an upper side of the upper jaw 178 a. The arms 42a, 42 b can thus be located distal to a tapered proximal portion 184 tof the cavity 186 and to a proximal-most portion 184 p of the cavity186. The location of the plate 36, e.g., the arms 42 a, 42 b thereof,relative to the upper jaw 178 a can be visually confirmed through thewindow 160 a of the loader 142.

The loader 142 having been advanced in the first direction D1 toward theend effector 176 to seat the distal tip 180 of the upper jaw 178 a (andalso possibly the distal tip 182 of the bottom jaw 178 b, as in thisillustrated embodiment) in the cavity 144, the loader 142 can then beadvanced in a second direction, indicated by arrows D2 in FIGS. 25A and26, relative to the end effector 176. The advancement can be due to theloader 142 moving relative to the end effector 176 or the end effector176 moving relative to the loader 142. The second direction D2 issubstantially perpendicular to the first direction D1. The seconddirection D2 is thus substantially parallel to the loader's longitudinalaxis A3 and substantially parallel to the longitudinal axis A4 of theupper jaw 178 a. A person skilled in the art will appreciate that thefirst direction D1 may not be precisely perpendicular to the seconddirection D2 but nevertheless be considered to be substantiallyperpendicular due to, e.g., tolerances in measurement devices.Similarly, a person skilled in the art will appreciate that the seconddirection D2 may not be precisely parallel to the axis A4 butnevertheless be considered to be substantially parallel due to, e.g.,tolerances in measurement devices.

The advancement of the loader 142 in the second direction D2 can causethe arms 42 a, 42 b of the plate 36 to slide within the upper jaw'scavity 186 into and through the cavity's tapered proximal portion 184 tand then into the cavity's proximal-most portion 184 p within which thearms' protrusions 43 a, 43 b can be seated, as shown in FIGS. 27A and27B. The protrusions 43 a, 43 b being seated in the cavity'sproximal-most portion 184 p can lock the plate 36 in the upper jaw 178a, as discussed above. The location of the plate 36, e.g., the arms 42a, 42 b thereof, relative to the upper jaw 178 a can be visuallyconfirmed through the window 160 a of the loader 142. The locking of theplate 36 within the upper jaw 178 a can thus be visually confirmed. Theangling of the plate 36 within the loader 142 prior to the plate 36being seated in the end effector 176 can facilitate positioning of theplate 36 under the upper jaw's retention tabs 188 a, 188 b during theloader's advancement in the second direction D2.

The plate 36 having been seated in the upper jaw 178 a, e.g., lockedtherein, the loader 142 can be removed from the instrument 172. As shownin FIG. 28, the loader 142 can be removed from the instrument 172, withthe plate 36 remaining in the upper jaw 178 a, by the loader 142 beingadvanced in a third direction, indicated by arrows D3, relative to theend effector 176. The advancement can be due to the loader 142 movingrelative to the end effector 176 or the end effector 176 moving relativeto the loader 142. The third direction D3 is opposite to the seconddirection D2, e.g., the third direction D3 is a distal direction and thesecond direction D2 is proximal a direction. With the loader 142 removedfrom the instrument 172 and the plate 36 loaded into the end effector176, the instrument 172 can be used in a surgical procedure tofacilitate passage of suture through tissue, as discussed herein.

As mentioned above, the plate 36 can be removably and replaceably seatedin the upper jaw 178 a. The plate 36 can be removed from the upper jaw178 a in a variety of ways. FIG. 29 illustrates one embodiment ofremoving the plate 36 from the upper jaw 178 a. As shown, a grasper 190can grasp the plate 36 seated in the upper jaw 178 a. Another tool(e.g., a hemostat, etc.) can be used instead of the grasper 190, or theplate 36 can be grasped by hand. The plate 36 can deform upward duringuse, as discussed herein, such that a distal portion of the plate 36 isbent upwards. This upwardly bent distal portion of the plate 36 may makethe plate 36 easier to grasp for removal from the instrument 172. Thegrasper tool 190 (or other tool or hand), grasping the plate 36, canpull the plate 36 out of the upper jaw 178 a. The removed plate 36 canthen be disposed of in a medical waste bin 192 or otherwise per theappropriate medical waste disposal protocol.

The loaders 142, 164 of FIGS. 20 and 23 are each one-piece loadingelements. A person skilled in the art will appreciate that a one-pieceloader may include multiple pieces for assembly purposes, with theassemblage thereof resulting in the one-piece loader. In otherembodiments, a loader can be a two-piece loading element that includestwo independent one-piece loading members configured to cooperate withone another to load a retention plate into a surgical instrument. Aperson skilled in the art will appreciate that each of the loadingmembers may include multiple pieces for assembly purposes, with theassemblage thereof resulting in the loading member. In general, thetwo-piece loader can be configured to receive a distal portion of asurgical instrument therein, and movement of one of the loading membersrelative to the other of the loading members can cause a plate seated inthe loader to move from being seated in the loader to being seated inthe distal portion of the surgical instrument received by the loader.The surgical instrument may then be removed from the loader with theplate remaining seated in the surgical instrument.

FIGS. 30-35 illustrate one embodiment of a loading element 200 includinga first loading member 202 and a second loading member 204. The “firstloading member” is also referred to herein as an “outer housing” and an“outer member,” and the “second loading member” is also referred toherein as an “inner housing” and an “inner member.” The inner member 204can be configured to be seated at least partially within the outermember 202, as shown in FIGS. 30-35. FIGS. 36-38 illustrate the outermember 202 as an independent element, and FIGS. 39-41 illustrate theinner member 204 as an independent element.

The loading element 200 can be configured to facilitate loading of aplate (not shown) into a surgical instrument (not shown) configured topass a suture through tissue. The loader 200 can be configured to havethe plate loaded therein for delivery of the plate to the surgicalinstrument. The plate can be pre-loaded therein, e.g., duringmanufacturing. The plate may thus be properly loaded into the loader 200since it is loaded therein according to manufacturing specifications.Alternatively, the loader 200 may not have the plate pre-loaded therein,and the plate can be manually loaded into the loader 200 by a user. Theuser may thus select by preference a particular plate.

The loader 200 can be disposable. In other words, after the loader 200is used to load the plate into a surgical instrument, the loader 200 canbe disposed of according to applicable standards of discarding usedmedical devices or elements thereof. The loader 200 being disposable maylimit improper loading of a retention plate therein, and hence improperdelivery of the plate to a surgical instrument, since the loader 200 canbe pre-loaded with a plate and disposed after the one loading of the oneplate into a surgical instrument.

In general, as discussed further below, the outer member 202 can beconfigured to movably seat the inner member 204 therein, the innermember 204 can be configured to removably and replaceably seat aretainer plate therein, and the inner member 204 can be configured toreceive a distal portion of a surgical instrument therein, such as atleast a portion of an end effector of the instrument. Movement of one ofthe outer and inner housings 202, 204 relative to the other can beconfigured to cause the plate seated in the inner member 204 to movefrom being seated in the loader 200 (e.g., from being seated in theinner member 204) to being seated in the distal portion of the surgicalinstrument received by the inner housing 204. In other words, the platecan move from being seated in the loader 200 to being seated in thesurgical instrument (e.g., seated in an upper jaw of an end effector ofthe instrument) in response to the movement of the inner housing 204and/or the outer housing 202. This movement of the plate from the loader200 to the end effector can be automatic such that the act of thehousing movement automatically causes the plate to move from the loader200 to the surgical instrument. The plate may thus be easily loaded intothe surgical instrument using the loader 200. No loading accessoriesother than the single loader 200 may be needed to accomplish the loadingof the plate into the surgical instrument, thereby reducing equipmentcosts and/or resulting in a simple plate-loading procedure. The loader200 can be configured such that, when the outer housing 202 is held inposition (by hand and/or by tool) distal movement of the instrumentreceived by the inner housing 204 can move the inner housing 204distally within the outer housing 202.

The outer member 202 can have a variety of sizes, shapes, andconfigurations. The outer member 202 can include an internal cavity 206therein. The internal cavity 206 can be defined by a top or upper side208 of the outer member 202, by opposed lateral sides 210 a, 210 b ofthe outer member 202, and by a back or distal side 212 of the outermember 202. The outer member 202 can have an opening 214 at a proximalend 216 thereof that provides access to the internal cavity 206. Theouter member 202 can have an open bottom or lower side. The bottom sidebeing open may allow for visualization of the inner member 204 seatedwithin the outer housing 202, as shown in FIG. 33. This visualizationmay help a user determine how much of the inner member 204 is disposedwithin the outer member 202, e.g., within the internal cavity 206thereof. In other words, this visualization may help a user determinehow far distally the inner member 204 has been advanced into the cavity206.

The outer member 202 can be configured to receive the inner member 204therein, e.g., within the inner cavity 206, in a single predeterminedorientation relative thereto. The outer member 202 can include anengagement member 218 configured to cooperate with a correspondingengagement member 220 of the inner member 204, which is discussedfurther below, to orient the outer and inner members 202, 204 in apredetermined orientation with one another. The corresponding engagementmembers 218, 220 can thus be configured to prevent the inner housing 204from being inserted into the inner cavity 206 of the outer housing 202in any orientation other than the single predetermined orientation. Theinner member 204 being receivable in the outer member 202 in only onepredetermined orientation may prevent the inner member 204 from beinginserted into the inner cavity 206 in an orientation relative to theouter member 204 in which the plate seated in the inner member 204cannot be properly loaded into a surgical instrument mated to the loader200. In other words, the inner member 204 being receivable in the outermember 202 in only one predetermined orientation may ensure that theouter and inner members 202, 204 are mated together in a relationshipwith each other to allow proper loading of the plate into theinstrument.

The outer member's engagement member 218 can be configured to facilitateengagement of the outer member 202 with the inner member 204. Theengagement member 218 can have a variety of sizes, shapes, andconfigurations. As shown in FIGS. 36-38, the outer member's engagementmember 218 can include one or more rails extending longitudinally alongan interior surface 222 a, 222 b of the outer member 202, with a firstinterior surface 222 a being on one lateral side 210 a of the outerhousing 202 and a second interior surface 222 b being on the otherlateral side 210 b of the outer housing 202. The outer member 202includes four rails in this illustrated embodiment (one of the rails onone side 210 a of the outer member 202 is obscured in FIGS. 36-38 but isvisible in FIG. 44, which is discussed further below) but can includeanother number, e.g., one, two, three, five, etc. As discussed furtherbelow, the inner member's engagement member 220 in this illustratedembodiment includes one or more tracks extending longitudinally along anexterior surface 224 a, 224 b of the inner member 204 that can beconfigured to slidably engage the one or more rails 218, with a firstexterior surface 224 a being on one lateral side of the inner housing204 and a second exterior surface 224 b being on another, oppositelateral side of the inner housing 204. Alternatively, the outer member'sengagement member can include one or more tracks, and the inner member'sengagement member can include one or more rails configured to slidablyengage the one or more tracks.

The outer member 202 can include a boss 226 (see FIGS. 31 and 44)configured to urge a plate seated in the inner member 202 out of theinner member 204 (and hence out of the loader 200) and into the surgicalinstrument received by the inner member 204. The boss 226 can extenddownwardly from an interior surface 228 of the top side 208 of the outermember 202. In this illustrated embodiment, the boss 226 includes alongitudinally extending tab. The boss 226 can be located distal to aproximal-most end 230 of the outer member's engagement member 218,thereby allowing the engagement members 218, 220 to be engaged beforethe boss 226 begins urging the plate out of the inner member 204. Theouter and inner members 202, 204 may thus be properly oriented relativeto one another before the plate begins moving out of the loader 200 andinto the surgical instrument such that the plate may be properly loadedinto the instrument without being misaligned relative to the instrumentand/or becoming deformed during the loading process.

The outer member 202 can include one or more protrusions 232 configuredto facilitate confirmation of complete advancement, e.g., full distalmovement, of the inner member 202 into the internal cavity 206 of theouter member 202. A plate seated in the inner member 204 when the innermember 204 has been fully advanced out of the inner member 204 beforethe inner member 204 has been completely advanced into the outer member202. The confirmation of the inner member's complete advancement intothe outer member 202 thus confirms that the plate has been fullyadvanced out of the loader 200 and has been fully advanced into thesurgical instrument. As discussed further below, the one or moreprotrusions 232 can be configured to cooperate with one or more ribs 234of the inner member 204 to facilitate the confirmation of completeadvancement of the inner member 204 into the internal cavity 206 of theouter member 202 by providing audible confirmation thereof. In general,the one or more protrusions 232 engaging the one or more ribs 234 cangenerate an audible sound and can be tactilely felt by a user using theloader 200. The confirmation of complete advancement can thus be audibleand tactile. The outer member 202 includes two protrusions 232 in thisillustrated embodiment (only one of the protrusions 232 is visible inFIG. 36 near one lateral side 210 b, but a similar protrusion is locatednear the other lateral side 210 a), but an outer member can includeanother number of protrusions (e.g., one, three, four, etc.). The one ormore protrusions 232 extend downwardly from the interior surface 228 ofthe top side 208 of the outer member 202 near the outer member'sproximal end 216 in this illustrated embodiment, but any of the outermember's internal surfaces can include any number of the one or moreprotrusions 232. The one or more protrusions 232 are spherical sectionsin this illustrated embodiment, but the one or more protrusions 232 canhave another shape.

The outer member 202 can include one or more holes 238 formed in the topsurface 208 thereof. The outer member 202 includes four holes 238 inthis illustrated embodiment, but an outer member can include anothernumber of holes (e.g., one, two, three, five, etc.). The one or moreholes 238 are longitudinally extending rectangles in this illustratedembodiment, but an outer member can include hole(s) in differentorientations and/or having different shapes. As shown in FIG. 35, theone or more holes 238 can be configured to facilitate visualization ofthe inner member 204 within the inner cavity 206 of the outer member202.

The outer member 202 can include a proximal cut-out 236 configured tofacilitate visual confirmation of the inner member's completeadvancement into the inner cavity 206 of the outer member 204 and,hence, complete advancement of the plate out of the loader 200 and intothe surgical instrument. The cut-out 236 has a half-moon shape in thisillustrated embodiment but can have another shape. By being located atthe proximal end 216 of the outer member 202, a proximal end of theplate loaded into an instrument using the loader 200 can be visibletherethrough. Thus, protrusions at proximal ends of opposed arms of theplate can be visible through the proximal cut-out. The plate's properseating in the instrument may thus be visually verified, e.g., movementof the arms' protrusions into a proximal-most portion of a cavity formedin the instrument's upper jaw.

The outer member 202 can include one or more distal openings 240 (seeFIG. 36) formed in the back or distal side 212 thereof. The outer member202 includes one distal opening 240 in this illustrated embodiment, butan outer member can include another number of distal openings (e.g.,two, three, four, etc.). The one or more distal openings 240 arecircular in this illustrated embodiment, but an outer member can includedistal opening(s) having another shape. The one or more distal openings240 can be configured to facilitate removal of the inner member 204 fromthe internal cavity 206 of the outer member 202. When the inner member204 is advanced into the outer member 202, there may not be enough (orany) of the inner member 204 extending proximally beyond the proximalend 216 of the outer member 202 so as to not provide enough (or any)proximal portion of the inner member 204 to be grasped for pulling ofthe inner member 204 out of the outer member's internal cavity 206.Similarly, when the inner member 204 is advanced into the outer member202, there may not be enough (or any) space between distal ends of theouter and inner members 202, 204 such that a finger or a tool cannot beinserted therebetween through the open bottom side of the outer member202 to push the inner member 204 out of the outer member's internalcavity 206. The one or more distal openings 240, being formed throughthe outer member's back side 212 can be accessible even when the innermember 204 is fully advanced into the outer member 202. A tool can beinserted into the one or more distal openings 240 and used to push theinner member 204 out of the outer member's internal cavity 206, eitherfully out or partially out before the inner member 204 is otherwiseremoved from the outer member 202 (e.g., pulling of the inner member 204by hand). Even if the loader 200 is disposable such that the innermember 204 need not be removed from the outer member 202 for reuse, theinner member 204 may need to be removed from the outer member 202 duringuse for any number of reasons, such as a desire to load a differentplate into the loader 200, a desire to clean the loader 200 of fluidand/or other matter, etc.

The inner member 204 can have a variety of sizes, shapes, andconfigurations. As shown in FIGS. 39, 42, and 43, the inner member 204can include first and second halves 242, 244 that can be coupledtogether to form the inner member 204. The inner member 204 being twopieces may facilitate manufacturing of the inner member 204. In otherembodiments, an inner member can be a single piece or can include morethan two pieces that together form the inner member. One of the innermember's halves 242 can include one or more pegs 246 configured to bereceived in one or more corresponding holes 248 formed in the other half244 to facilitate assembly of the inner member 204. Each of the pegs 246can have a different size, e.g., a different diameter. Each of the holes248 can also have a different size, e.g., a different diameter. Thedifferently sizes pegs 246 and holes 248 may prevent the inner member204 from being assembled in any way other than one. In other words, thehalves 242, 244 can be configured to be coupled together in only onepredetermined orientation relative to one another. The inner member 204may thus be properly assembled.

The inner member 204 can include a proximal bore 258 formed therein. Thebore 258 can be formed in a proximal portion of the inner member 204,e.g., formed through a proximal end 260 of the inner member 204. Thebore 258 can be configured to receive at least a distal portion of anend effector of a surgical instrument therein. The bore 258 can thushave a size and shape configured to facilitate introduction of at leasta portion of an instrument's end effector therein. The bore 258 can beconfigured to receive the end effector therein in only one predeterminedorientation relative to the inner member 204. The end effector (e.g., anupper jaw thereof) may thus be properly positioned relative to the plateloaded in the inner member 204 for delivery of the plate from the loader200 to the end effector.

The bore 258 can have a cross-sectional shape configured to receive theend effector therein in only the one predetermined orientation. Endeffectors of surgical instruments configured to facilitate passage ofsuture through tissue traditionally have a “D” cross-sectional shapewhen closed. Thus, as shown in FIGS. 30, 33, 39, and 41, the bore 258can have a D-shaped cross-section. Additionally, end effectors ofsurgical instruments configured to facilitate passage of suture throughtissue traditionally have a smallest cross-sectional shape when closed,e.g., when jaws of the end effector are closed. The bore 258 can besized such that the end effector being open has a size too large to beinserted into the bore 258. The bore 258 can thus be configured toreceive an end effector therein only when the end effector is closed.The end effector (e.g., an upper jaw thereof) may thus be furtherensured to be properly positioned relative to the plate loaded in theinner member 204 for delivery of the plate from the loader 200 to theend effector.

The inner member 204 can include a seat 250, illustrated in FIGS. 42-44,configured to removably and replaceably seat a retainer plate 36 priorto loading of the plate 36 into a surgical instrument 254 disposedwithin the bore 258. The plate 36 is in a loading configuration in sucha position seated on the seat 250 prior to beginning its movement intothe instrument 254. The plate 36 of FIG. 3 is shown seated in the seat250 in FIG. 44 and is discussed below with respect to the loader 200 forease of explanation, but the seat 250 can seat other types of plates,e.g., a plate similar to the plate 36 but formed from a differentmaterial, the plate 48 of FIG. 5, etc. Similarly, although FIG. 44 showsa portion of an end effector 252 of the surgical instrument 254 receivedin the inner member 204 for delivery of the plate 36 thereto, otherinstruments can be received in the inner member 204, e.g., theinstrument 10 of FIG. 1, the instrument 80 of FIG. 8, etc., for deliveryof the plate 36 (or other plate) thereto.

The seat 250 can include an elongate, longitudinally-extending channelformed in an interior of the inner member 204. The seat 250 can have asize and shape that generally corresponds to a size and shape of theplate 36 to be seated thereon 250.

The seat 250 can be located in a distal portion of the inner member 204.In this way, as the inner member 204 is advanced distally within theouter member's inner cavity 206 such that the inner member 204 isbecoming closer to the outer member's distal side 212, the plate 36 canbe urged out of the inner member 204 by the boss 226 and into the endeffector 252, e.g., into an upper jaw 256 of the end effector 252. Theplate 36 can be configured to remain at a substantially fixed axialposition relative to the outer member 202 during the inner member'sdistal advancement, e.g., at a substantially fixed position along alongitudinal axis A6 of the outer member 204 (see FIGS. 35 and 37). Aperson skilled in the art will appreciate that the position may not beprecisely fixed axially but nevertheless be considered to besubstantially fixed axially due to, e.g., manufacturing tolerances, atexture thereon, and/or tolerances in measurement devices. The boss 226can be configured to hold the plate 36 in the substantially fixed axialposition during the inner member's distal advancement, thereby allowingthe plate 36 to move from the seat 250 of the inner member 204 to theend effector 252 (e.g., the upper jaw 256 thereof) since the endeffector 252 is advancing distally with the inner member 204.

The inner member 20 can include a longitudinal slot 262 formed in a topor upper side 264 thereof. The slot 262 can be in communication with theseat 250. The slot 262 can be configured to slidably receive the boss226 therein. The boss 226 can therefore be configured to slide withinthe slot 262 and engage the plate 36 seated in the seat 250 to urge theplate 36 into the end effector 252. The slot 262 can extend from adistal end 264 of the inner member 204 to a position proximal to theinner member's proximal end 260. The slot 262 can thus have an opendistal end and a closed proximal end. The slot's distal end being openmay facilitate entry of the boss 226 into the slot 262. The slot'sproximal end being closed may facilitate the stoppage of movement of theinner member 204 within the inner cavity 206 of the outer member 202,which may help prevent damaging the loader 200, the plate 37, and/or theinstrument 254.

As mentioned above, the inner member 204 can include an engagementmember 220 configured to cooperate with the outer member's engagementmember 218 to facilitate orientation of the inner member 204 relative tothe outer member 202. The engagement member 220 can have a variety ofsizes, shapes, and configurations. As mentioned above, the engagementmember 220 in this illustrated embodiment includes one or more tracksextending longitudinally along the exterior surface 224 a, 224 b of theinner member 204 but can have other configurations. The inner member 204includes two tracks 220 to correspond to the outer member's two rails218 but in other embodiments can have another number of tracks.

Each of the tracks 220 can have an open distal end 220 d and a closedproximal end 220 p. The open distal ends 220 d may facilitate entry ofthe rails 218 into the tracks 220. The closed proximal ends 220 p mayfacilitate the stoppage of movement of the inner member 204 within theinner cavity 206 of the outer member 202. If the outer member'sengagement member includes one or more tracks and the inner member'sengagement member includes one or more rails, each of the tracks canhave an open proximal end and a closed distal end, which may similarlyfacilitate the stoppage of movement of the inner member 204 within theinner cavity 206 of the outer member 202.

In this illustrated embodiment, the inner member 204 includes a hollowedspace 266 on each its opposed lateral sides 224 a, 224 b. The hollowedspaces 266 may allow less material to be needed to form the inner member204 and/or to otherwise facilitate manufacturing of the inner member204.

As mentioned above, the inner member 204 can include one or more ribs234 configured to cooperate with the outer member's one or moreprotrusions 232 to facilitate the confirmation of complete advancementof the inner member 204 into the internal cavity 206 of the outer member202. The inner member 204 includes a single rib 234 in this illustratedembodiment. The one or more ribs 234 are located near the inner member'sdistal end 260 in this illustrated embodiment to cooperate with the oneor more protrusions 232. In this way, the confirmation of completeadvancement (e.g., the audible and/or tactile confirmation) may beproduced when the inner member's distal end 260 approaches the outermember's proximal end 216.

The inner member 204 can include one or more ribs 268 located proximallyto the one or more ribs 234 configured to cooperate with the outermember's one or more protrusions 232 to facilitate the confirmation ofcomplete advancement of the inner member 204 into the internal cavity206 of the outer member 202. For ease of discussion, the one or moreribs 234 near the inner member's proximal end 260 are referred to hereinas “proximal ribs,” and the one or more ribs 268 located distally to theone or more proximal ribs 234 are referred to herein as “distal ribs.”The one or more distal ribs 234 can be configured to limit proximalmovement of the inner member 204 relative to the outer member 202 afterat least one of the distal ribs 234 has moved distally past one or moredistal protrusions (not shown) of the outer member 204 that are locateddistal to the one or more protrusions 232. In order for the inner member204 to move proximally, e.g., in a direction toward its exit from theinner cavity 206, the one or more distal ribs 234 and the outer member'sone or more distal protrusions can be configured to cooperate to requirethat a threshold amount of force be applied to at least one of the outerand inner members 202, 204 to allow proximal movement of the innermember 204 relative to the outer member 202. The one or more distal ribs234 and the outer member's one or more distal protrusions can thus beconfigured to cooperate to help prevent accidental back-out of the innermember 204 from the outer member 202.

In this illustrated embodiment, the inner member 204 includes two distalribs 268. The two distal ribs 268 can define a trough 270 therebetween.The outer member's one or more distal protrusions can be configured tosettle within the trough 270 after one of the distal ribs 268 passesdistally beyond the outer member's one or more distal protrusions. Thesettling in the trough 270 may help hold the outer and inner members202, 204 in a fixed position relative to one another until thepredetermined amount of force is applied to at least one of the outerand inner members 202, 204 to allow proximal movement of the innermember 204 relative to the outer member 202. The more distal of the twodistal ribs 268 can have a higher profile, e.g., a greater height, thanthe more proximal of the two distal ribs 268, as shown in FIGS. 40, 42,44. This higher profile may facilitate settling of the outer member'sone or more distal protrusions in the trough 270, as opposed to passingdistally passed the more distal of the two distal ribs 268. Instead ofincluding two distal ribs 268, an inner member can include one distalrib, three distal ribs (so as to define three troughs), etc.

The inner member 204 can include a proximal cut-out 272 configured tofacilitate visual confirmation of the inner member's completeadvancement into the inner cavity 206 of the outer member 204 and,hence, complete advancement of the plate out of the loader 200 and intothe surgical instrument. The inner member's proximal cut-out 272 cangenerally be configured and used similar to the outer member's proximalcut-out 236, e.g., have a half-moon shape, facilitate visualization ofthe plate 36 seated in the upper jaw 256, etc.

As mentioned above, a surgical instrument configured to pass a suturethrough tissue and having a retainer plate loaded therein (e.g., loadedduring manufacturing, loaded by hand, or loaded using any of the loadingelements described herein) can be used in any of a variety of surgicalprocedures. FIGS. 46-56 illustrate one embodiment of a surgicalprocedure that can be performed using a surgical instrument 300, alsoshown in FIG. 45, having the plate 36 of FIG. 3 loaded therein. Theprocedure is illustrated with respect to the instrument 300 and theplate 36 but can be similarly performed using a different surgicalinstrument and/or a different plate. The instrument 300 can generally beconfigured and used similar to the instrument 10 of FIG. 1 and othersurgical instruments described herein, e.g., include an elongate shaft302 having the end effector 304 at a distal end thereof, be configuredto removably and replaceably seat a needle 306 (see FIG. 51), include ahandle portion 308 (see FIGS. 49-53), etc. The instrument 300 is shownwith the plate 36 of FIG. 3 loaded therein, but the instrument 300 canbe used with this plate 36 and/or other plates, e.g., a plate similar tothe plate 36 but formed from a different material, the plate 48 of FIG.5, the plate 72 of FIG. 7, etc. The instrument's end effector 304 cangenerally be configured and used similar to the end effector 16 of FIG.1 and other end effectors described herein, e.g., include upper andlower jaws 310 a, 310 b, be movable between open and closed positions,etc. In this illustrated embodiment, the end effector 304 includes upperand lower jaws 310 a, 310 b, with the upper jaw 310 a being configuredto move relative to the lower jaw 310 b and the elongate shaft 302. Theupper jaw 310 a can generally be configured and used similar to theupper jaw 86 a of FIG. 8 and other upper jaws described herein. In thisillustrated embodiment, the upper jaw 310 a has a gap 312 formed therein(e.g., has a non-continuous upper rim 313), has a non-linear interiorsurface 314, includes a pair of retention tabs 316 a, 316 b, has acavity 318 formed in an upper side thereof that includes a distalportion, a tapered proximal portion, and a proximal-most portion, etc.

FIG. 45 illustrates the plate 36 properly loaded in the upper jaw 310 a,with the arms 42 a, 42 b of the plate 36 locked in position within thecavity 318, e.g., with the arms' protrusions 43 a, 43 b locked withinthe cavity's proximal-most portion. After the plate 36 is loaded intothe instrument 300, the needle 306 can be loaded into the instrument300. Embodiments of needle loading are further described in previouslymentioned U.S. Pat. No. 8,540,732 entitled “Suturing Apparatus AndMethod” filed Dec. 17, 2010. Alternatively, the needle 306 can be loadedinto the instrument 300 before the plate 36 is loaded therein. After theplate 36 and the needle 306 are loaded into the instrument 300, a suture320 can be loaded into the end effector 304, e.g., into the bottom jaw310 b. FIGS. 46-48 illustrate loading of the suture 320 into the endeffector 304, e.g., into the bottom jaw 310 b. Alternatively, the suture320 can be loaded into the end effector 304 before the plate 36 and/orbefore the needle 306. Embodiments of suture loading are furtherdescribed in previously mentioned U.S. Pat. No. 8,540,732 entitled“Suturing Apparatus And Method” filed Dec. 17, 2010.

With the plate 36, the needle 306, and the suture 320 loaded, a distalportion of the instrument 300 including the end effector 304 can beadvanced into a body of a patient, such as through a cannula 322, asshown in FIG. 47. The end effector 304 within the body can engage andbite a tissue 324, as shown in FIGS. 47 and 48, such that the tissue 324is clamped between the jaws 310 a, 310 b. The tissue 324 in thisillustrated embodiment includes a rotator cuff tissue. With the tissue324 clamped by the end effector 304, as shown in FIG. 49, the needle 306can be moved relative to the shaft 302 and the end effector 304 so as toadvance out of the end effector 304 and through the tissue 324. Theadvancement of the needle 306 can cause a distal portion of the plate 36to deform in an upward direction, as shown between the plate'sundeflected position in FIGS. 45-50 and the plate's deflected positionin FIG. 51. The advancement of the needle 306 can also cause the suture320 to advance out of the end effector 304, as shown in FIG. 51. Theportion of the suture 320 advanced out of the end effector 304 caninclude the loop previously loaded into the bottom jaw 310 b, as shown.The needle 306 can then be retracted, as shown in FIG. 52, leaving thesuture 320 (e.g., a loop thereof) outside of the end effector 304.

The retraction of the needle 306 can allow the plate 36 to move from thedeflected position toward the undeflected position, as shown between theplate's deflected position in FIG. 51 and the plate's partiallydeflected position in FIG. 52. In other words, the plate 36 can deformback toward the undeflected position. The plate 36 may not reach itsundeflected position and instead be partially deflected, as in thisillustrated embodiment, due to any one or more factors, such as theplate's deformable nature, the size of the suture 320, the force withwhich the needle 306 is advanced out of the end effector 304, etc. Asalso shown in FIG. 52, the suture 324 can be positioned between thedistal-most surface 46 of the plate 36 and the non-linear interiorsurface 314 of the upper jaw 310 a. As discussed above, the plate'sdistal-most surface 46 and the upper jaw's non-linear interior surface314 can cooperate to help the instrument 300 (e.g., the upper jaw 310 a)have a secure hold on the suture 320.

After the retraction of the needle 320, the end effector 304 can beopened, as shown in FIG. 53. The suture 320 remains passed through thetissue 324 and remains held by the instrument 300 (e.g., by the upperjaw 310 a). The instrument 300 can then be removed from the patient'sbody, e.g., by being retracted through the cannula 322. The end effector304 can be moved from the open position to the closed position, as shownin FIG. 54, to facilitate removal of the end effector 304 from thepatient's body since the end effector 304 has a smaller profile in theclosed position than in the open position. Since the suture 320 is heldby the instrument 300, the instrument's removal from the patient's bodydraws the suture 320 therewith. In other words, pulling the instrument300 out of the patient's body causes the suture 320 to be pulled out ofthe patient's body, with a portion of the suture 320 remaining passedthrough the tissue 324. As shown in FIG. 54, a first portion 320 a ofthe suture 320 (e.g., the loop of suture 320) can be held by the upperjaw 310 a, a second portion 320 b of the suture 320 extending from thefirst portion 320 a can extend toward the tissue 324 (not shown in FIG.54), a third portion (not shown in FIG. 54) of the suture 320 extendingfrom the second portion 320 b can be positioned within the tissue 324,and a fourth portion 320 c of the suture 320 extending from the thirdportion of the suture 320 can extend through the cannula 322 and outsidethe patient's body. FIG. 54 also illustrates a primary capture point 326of the suture 320 by the instrument 300 in the upper jaw 310 a betweenthe plate 36 (e.g., the plate's distal-most surface 46) and the upperjaw's non-linear interior surface 314, and a secondary capture point 328of the suture 320 by the instrument 300 between the upper and lower jaws310 a, 310 b, e.g., between a bucktooth 330 (see FIG. 53) of the upperjaw 310 a and a suture-engaging surface 331 (see FIG. 47) of the bottomjaw 310 b.

After the instrument 300 has been removed from the patient's bodythrough the cannula 322, the suture 320 can be disengaged (e.g., byhand) from the instrument 300, such as by being slid through the gap312. One or more additional sutures can be sequentially loaded onto theinstrument 300 and passed through the tissue 324, as shown in FIG. 55. Atotal of four sutures 320, 332, 334, 336 are passed through the tissue324 in this illustrated embodiment, but any number of sutures can bepassed through the tissue 324. As shown in FIG. 56, the sutures 320,332, 334, 336 passed through the tissue 324 can then be used to tensionthe tissue 324 in position using a suture anchor 338 advanced into thepatient's body through the cannula 322. Exemplary configurations of asuture anchor include the following anchors, all commercially availablefrom DePuy Mitek of Raynham, Mass.: HEALIX®, HEALIX PEEK®, and HEALIXBR®, and include suture anchors described in U.S. Pat. No. 8,114,128entitled “Cannulated Suture Anchor” issued Feb. 14, 2012, and U.S.Patent No. 2009/0076544 entitled “Dual Thread Cannulated Suture Anchor”filed Sep. 14, 2007, which are hereby incorporated by reference in theirentirety.

A person skilled in the art will appreciate that the implementationsdescribed herein have application in conventional minimally-invasive andopen surgical instrumentation as well application in robotic-assistedsurgery.

The devices disclosed herein can be designed to be disposed of after asingle use, or they can be designed to be used multiple times. In eithercase, however, the device can be reconditioned for reuse after at leastone use. Reconditioning can include any combination of the steps ofdisassembly of the device, followed by cleaning or replacement ofparticular pieces and subsequent reassembly. In particular, the devicecan be disassembled, and any number of the particular pieces or parts ofthe device can be selectively replaced or removed in any combination.Upon cleaning and/or replacement of particular parts, the device can bereassembled for subsequent use either at a reconditioning facility, orby a surgical team immediately prior to a surgical procedure. Thoseskilled in the art will appreciate that reconditioning of a device canutilize a variety of techniques for disassembly, cleaning/replacement,and reassembly. Use of such techniques, and the resulting reconditioneddevice, are all within the scope of the present application.

Preferably, components of the invention described herein will beprocessed before use. First, a new or used instrument is obtained and ifnecessary cleaned. The instrument can then be sterilized. This can bedone by any number of ways known to those skilled in the art includingbeta or gamma radiation, ethylene oxide, steam, and a liquid bath (e.g.,cold soak). In one sterilization technique, the instrument is placed ina closed and sealed container, such as a plastic or TYVEK bag. Thecontainer and instrument are then placed in a field of radiation thatcan penetrate the container, such as gamma radiation, x-rays, orhigh-energy electrons. The radiation kills bacteria on the instrumentand in the container. The sterilized instrument can then be stored inthe sterile container. The sealed container keeps the instrument sterileuntil it is opened in the medical facility.

One skilled in the art will appreciate further features and advantagesof the invention based on the above-described embodiments. Accordingly,the invention is not to be limited by what has been particularly shownand described, except as indicated by the appended claims. Allpublications and references cited herein are expressly incorporatedherein by reference in their entirety.

1. A surgical system, comprising: an outer member having an internalcavity therein and having proximal and distal ends, the proximal end ofthe outer member having an opening therein that is in communication withthe internal cavity; and an inner member having proximal and distal endsand being an independent element from the outer member, the distal endof the inner member being configured to be inserted through the openingof the outer member and into the internal cavity of the outer member,the inner member including a seat configured to removably andreplaceably receive a plate therein, the proximal end of the innermember having a bore formed therein, the bore being configured toreceive therein a distal end of a surgical instrument, wherein the innerand outer members are configured to cause the plate to advance into thebore from the seat in response to the inner member being inserted intothe internal cavity.
 2. The system of claim 1, further comprising aplate configured to removably and replaceably be received in the seat,the plate being configured to facilitate manipulation of a suture. 3.The system of claim 1, wherein the outer member has an internalprotrusion that extends into the internal cavity, the internalprotrusion being configured to push the plate into the bore from theseat.
 4. The system of claim 1, wherein the inner member has a singleposition relative to the outer member in which the inner member isconfigured to be inserted through the opening of the outer member andinto the internal cavity of the outer member.
 5. The system of claim 1,wherein the inner and outer members have corresponding engagementmembers configured to orient the inner and outer members relative to oneanother in a predetermined orientation.
 6. The system of claim 5,wherein the engagement member of one of the inner and outer membersincludes a slot, and the engagement member of the other of the inner andouter members includes a protrusion configured to slide within the slotduring the advancement of the inner member in the distal direction intothe internal cavity.
 7. The system of claim 1, wherein the inner memberhas a slot formed in an external surface thereof, the slot having anopen proximal end and a closed distal end.
 8. The system of claim 1,wherein the inner member includes a stop element configured to stopmovement of the inner member in the distal direction within the internalcavity once the inner member has advanced a predetermined amount intothe internal cavity.
 9. The system of claim 1, wherein the inner memberhas one or more ribs formed on a top surface thereof.
 10. The system ofclaim 1, wherein in response to the plate being fully advanced into thebore from the seat, at least one of the inner and outer members isconfigured to generate at least one of an audible confirmation and atactile confirmation of the full advancement.
 11. The system of claim 1,further comprising a surgical instrument having a distal end configuredto be received within the bore of the inner member, wherein the innerand outer members are configured to cause the plate to advance from theseat into the distal end of the surgical instrument within the bore ofthe inner member.
 12. The system of claim 11, wherein the distal end ofthe surgical instrument includes a pair of jaws configured to movebetween open and closed positions.
 13. The system of claim 11, whereinthe distal end of the surgical instrument is configured to be insertedinto the bore of the inner member in a single predetermined orientationrelative to the inner member.
 14. A surgical method, comprising:inserting the distal end of the surgical instrument into the bore of theinner member of claim 1, the inserting being performed by a user, andthe inserting causing the plate to advance into the bore from the seatsuch that the plate advances into the distal end of the surgicalinstrument; and removing from the bore the distal end of the surgicalinstrument having the plate advanced therein. 15-20. (canceled)
 21. Asurgical method, comprising: loading a plate into a cavity of a loadingelement such that the loading element releasably seats the plate;wherein: the loading element has an opening formed therein that is incommunication with the cavity; the opening is configured to have aportion of a surgical instrument extending therethrough such that an endeffector of the surgical instrument is aligned with the plate seated inthe loading element; and the plate is configured to be released from theloading element and into the end effector of the surgical instrumentwith the portion of the surgical instrument extending through theopening.
 22. The method of claim 21, wherein, with the portion of thesurgical instrument extending through the opening, moving the loadingelement or the surgical instrument relative to the other of the loadingelement and the surgical instrument causes the plate to be released fromthe loading element and seated in the end effector.
 23. The method ofclaim 22, wherein the loading element includes an outer member and aninner member; the inner member has the cavity formed therein; the innermember has the opening formed therein; and moving the loading element orthe surgical instrument relative to the other of the loading element andthe surgical instrument causes a boss of the outer member to urge theplate into the end effector of the surgical instrument.
 24. The methodof claim 21, wherein the plate includes a pair of arms extendingproximally therefrom; the opening is formed in a proximal end of theloading element; the end effector is at a distal end of the surgicalinstrument; and the surgical instrument is configured to pass a suturethrough tissue.
 25. The method of claim 24, wherein moving the loadingelement or the surgical instrument relative to the other of the loadingelement and the surgical instrument causes the arms to move laterallyapart from one another and then move laterally toward one another. 26.The method of claim 21, wherein the loading element includes an outermember and an inner member; the inner member has the cavity formedtherein; the inner member has the opening formed therein; the outermember has a protrusion extending therefrom; and with the portion of thesurgical instrument extending through the opening, the protrusion isconfigured to push the plate into the opening.